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	<title>用药咨询</title>
</head>
<body>
	<div class="medication-user">
		<div class="font3">
			<img src="../../images/doc-man.png" />
			陈医生
			<p>
				湖北省宜昌馨语心理医院
			</p>
			<p>
				科室名称
			</p>
		</div>
	</div>
	<form id="submitOrder">
		<div class="mui-input-group font3">
			<div class="mui-table-view-cell">
				<div class="mui-navigate-right">就诊人 <i class="mui-pull-right" id="choiceUser">请选择</i></div>
				<input type="hidden" placeholder="" class="archivesid" name="archivesid">
				<input type="hidden" placeholder="" class="doctorid" name="doctorid">
			</div>
			<div class="mui-input-row">
				<label>拟配药品</label>
				<input type="text" placeholder="请输入药品名" class="textR" name="drugsname">
			</div>
			<div class="mui-input-row">
				<label>所患疾病</label>
				<input type="text" placeholder="请输入所患疾病" class="textR" name="disease">
			</div>
			<div class="mui-input-row">
				<div class="medicaClass">是否服用过此药</div>
				<div class="medicaClick isMedicine">
					<div class="mui-radio mui-left">
				  		<label>无</label>
						<input name="istake" type="radio" value="0" checked="checked">
					</div>
					<div class="mui-radio mui-left">
				  		<label>有</label>
						<input name="istake" type="radio" value="1">
					</div>
				</div>
			</div>
			<div class="mui-input-row">
				<div class="medicaClass">服用后不良反应</div>
				<div class="medicaClick isUntoward">
					<div class="mui-radio mui-left">
				  		<label>无</label>
						<input name="isreflection" type="radio" value="0" checked="checked">
					</div>
					<div class="mui-radio mui-left">
				  		<label>有</label>
						<input name="isreflection" type="radio" value="1">
					</div>
				</div>
			</div>
			<div class="mui-input-row">
				<div class="medicaClass">是否有过敏史</div>
				<div class="medicaClick isAllergy">
					<div class="mui-radio mui-left">
				  		<label>无</label>
						<input name="isallergy" type="radio" value="0" checked="checked">
					</div>
					<div class="mui-radio mui-left">
				  		<label>有</label>
						<input name="isallergy" type="radio" value="1">
					</div>
				</div>
				<div class="mui-input-row pat-allergy" id="allergyRemarks">
			        <label>对什么过敏</label>
			    	<input type="text" class="textR" placeholder="请填写过敏源(最多16字)" name="allergydrugs">
			    </div>
			</div>
		</div>
		<div class="medication-write">
			<textarea rows="5" placeholder="输入您的病情概要，当前病情状态以及希望对医生特别说明的事情。" name="explain"></textarea>
			<div class="upload camera-area">
				<ul class="thumb">
					<!-- 框-->
					<li class="addFile">
						<div class="add">
							<input type="file" accept="image/*" class="photos fileToUpload" id="fileToUpload" name="fileToUpload" onclick="javascript:this.value=''"/>
						</div>
					</li>
				</ul>
				<p class="font1">
					<!--上传图片资料病例</br>让医生更了解您的病情-->
					上传疾病诊断及说明</br>(病历，过往处方单或其他诊断证明)
				</p>
			</div>
		</div>
		<div class="medication-prompt">
			咨询说明：
			</br>1.若医生在您发起咨询后拒绝或24小时内未回复，系统将自动为您退款；
			</br>2.医生回复仅为建议，具体诊治请前往医院进行；
			</br>3.在线开药仅支持病情稳定且已确诊的慢病患者，危重症患者请到医院就医。
		</div>
	</form>
	<div class="choice-doctorSubmit">
		<button class="submitOrder">提交</button>
	</div>
</body>
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